Nasal Intermittent Positive Pressure Ventilation(NIPPV) for the Patient with Progressive Muscular Dystrophy.

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  • OTAKE Susumu
    Department of Orthopedic Surgery, Iwaki Byouin National Sanatorium

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  • 筋ジストロフィーに対する鼻マスクによる人工呼吸（ＮＩＰＰＶ）の試み
  • キン ジストロフィー ニ タイスル ビ マスク ニ ヨル ジンコウ コキュウ

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Nocturnal hypoxia has been observed in many cases of the patients with progressive muscular dystrophy. Nine patients with respiratory failure were treated by nasal intermittent positive pressure ventilation (NIPPV). The diagnosis was Duchenne muscular distrophy in six cases, myotonic dystrophy in two cases and limb-girdle distrophy in one case, and the period of follow up was from 114 to 568 days. The criteria of starting NIPPV were following; acute respiratory failure due to pneumonia or pulmonary infarction, and chronic respiratory failure with severe nocturnal hypoxia. Volume type ventilator and nasal mask system (Respironiks, Inc.) was used and the mouth guard and closing mouth prevented the airleakage from the mouth. NIPPV was applied only in the night in 8 cases and both the day and night in one case.<br>In all patients, hypoxia and hypercapnea soon improved in not only during nighttime but also daytime, and NIPPV were tolerated well. The only complication of NIPPV observed was slight skin erosion at the bas of nose by nasal mask in seven patients, which was not severe.<br>NIPPV was not invasive in comparison with ventilation via tracheostomy, and more effective than cuirass respirator. It was suggested that NIPPV was useful in the post operative management after extubation of endotracheal tube, and postponed tracheostomy.

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